Alloy / Rosacea Face Cream Rx
AZELAIC 17% + METRONIDAZOLE 1.11% + IVERMECTIN 0.88%
All three first-line rosacea topicals in one anhydrous, preservative-free, airless-pumped base, with every concentration published and the actuator volume given to a tenth of a millilitre. It is the best-made compounded product in this register. Nobody has ever trialled the combination, one active sits below its approved strength, and the page still does not say how often to use it.
Worth buying for a specific person with a specific problem. Read who.
ASSESSED ON 75% OF THE MODEL. 2 CRITERIA LEFT UNSCORED — SEE SCORING FOR WHY.
Ask how many actuations, how often, and for how long the metronidazole runs. The formulation work here is excellent; the instructions are missing.
The verdict
This is the best-formulated compounded product in the register, and the first Alloy page where the formulation work is visibly the point. Three actives, all first-line for rosacea, all published with concentrations: azelaic acid 17%, metronidazole 1.11%, ivermectin 0.88%. A full ingredient list follows, and reading it is instructive — C13-15 alkane, caprylyl methicone, cyclopentasiloxane, dimethicone, moringa and passionfruit seed oils, tocopherol. There is no water in it. An anhydrous base needs no preservative, and there is none: no phenoxyethanol, no parabens, nothing for inflamed rosacea skin to react to. That is a deliberate and expensive choice.
It goes further. The vehicle carries diethylene glycol monoethyl ether and dimethyl isosorbide, two genuine penetration enhancers, which is what you would use to drive azelaic acid into skin from an anhydrous base. It ships in an airless pump, which is right for these actives. And the page publishes the actuator volume — 0.3 ml per press — which no other product in fifty-four reviews has done. Somebody here is a formulator.
The claim we expected to challenge turned out to be sound. 'Rosacea is related to hormonal imbalance, with the incidence and severity rising for women aged 45 and older' reads like a menopause company bending a condition toward its own franchise. It is defensible: oestrogen is a vasomodulator, the estradiol protective hypothesis links falling oestrogen to rosacea in perimenopause, and prevalence does rise in this group. A menopause company is better placed than a general skincare brand to make that point, and it made it accurately.
Three things hold it back. No trial has ever tested azelaic acid, metronidazole and ivermectin together — each is first-line alone, the combination is inference. Ivermectin at 0.88% sits below the 1% at which it was trialled and approved, which is the odd direction for the pool's strongest single agent to be diluted. And having published the actuator volume to a tenth of a millilitre, the page states no frequency and no bottle size, so the three-month supply still cannot be checked. That is now four Alloy pages that come one number short of a verifiable claim.
- Publishes all three active concentrations: azelaic acid 17%, metronidazole 1.11%, ivermectin 0.88%.
- Publishes the full ingredient list, including the vehicle.
- An anhydrous base, so no preservative is required and none is present — a real advantage on inflamed rosacea skin.
- Penetration enhancers appropriate to delivering azelaic acid from a waterless vehicle.
- Ships in an airless pump, correct for these actives.
- States the actuator volume — 0.3 ml per press — which nothing else in this register does.
- All three actives are genuinely first-line for papulopustular rosacea, acting by three different mechanisms.
- The hormonal framing is accurate: falling oestrogen is plausibly linked to rosacea in perimenopause, and prevalence does rise in this group.
- Fragrance-free, with a named medical reviewer and a real safety question in the FAQ.
- $33 a month for three prescription actives, against several times that for the approved products bought separately.
- No trial has tested azelaic acid, metronidazole and ivermectin in combination.
- Ivermectin at 0.88% is below the 1% at which it was approved — the pool's strongest agent, diluted.
- None of the three departures from approved strengths is acknowledged or explained.
- No application frequency stated, so the actuator volume cannot be turned into a daily dose.
- No bottle size, so the three-month supply claim remains unverifiable.
- No pregnancy content, for the sixth Alloy page in a row.
- No sunscreen or SPF guidance, on a condition where ultraviolet is a leading trigger.
- A topical antibiotic sold for 'everyday use' with no review point and no mention of resistance.
- 'Less Burning and Stinging' sits as a heading above a formula containing 17% azelaic acid.
- No trigger-avoidance guidance, which for rosacea is half the treatment.
Every active, assessed
- Azelaic Acid17%
Anti-inflammatory, normalises keratinisation, reduces reactive oxygen species and cathelicidin processing
- BENCHMARK
- 15% is the concentration approved for rosacea
- ASSESSMENT
- Above the approved rosacea strength and below the 20% approved for acne, which is the arithmetic of blending three products into one. Well chosen — azelaic acid acts on the cathelicidin pathway now understood to be central to rosacea. It is also the most reliably stinging topical in the category, which makes the page's 'Less Burning and Stinging' heading an odd one to place above it.
- Metronidazole1.11%
Anti-inflammatory topical antibiotic — the long-standing first-line agent
- BENCHMARK
- 0.75% and 1% are the approved concentrations
- ASSESSMENT
- Slightly above both approved strengths, published honestly. Decades of trial support for inflammatory lesions. It is a topical antibiotic sold for 'everyday use' with no stated review point and no mention of resistance anywhere on the page — a smaller concern for topical than oral metronidazole, but the kind of thing a stated duration would settle.
- Ivermectin0.88%
Antiparasitic and anti-inflammatory — reduces Demodex density and the response to it
- BENCHMARK
- 1% is the approved concentration
- ASSESSMENT
- The strongest single agent in topical rosacea, and the one diluted below its approved strength. A twelve per cent shortfall is unlikely to matter much clinically and it is an honest consequence of compounding three products together — but of the three, this is the one you would least want to weaken, and the page does not acknowledge that any of the numbers depart from their approved values.
| ACTIVE | CONC. | BENCHMARK | ASSESSMENT |
|---|---|---|---|
| Azelaic AcidAnti-inflammatory, normalises keratinisation, reduces reactive oxygen species and cathelicidin processing | 17% | 15% is the concentration approved for rosacea | Above the approved rosacea strength and below the 20% approved for acne, which is the arithmetic of blending three products into one. Well chosen — azelaic acid acts on the cathelicidin pathway now understood to be central to rosacea. It is also the most reliably stinging topical in the category, which makes the page's 'Less Burning and Stinging' heading an odd one to place above it. |
| MetronidazoleAnti-inflammatory topical antibiotic — the long-standing first-line agent | 1.11% | 0.75% and 1% are the approved concentrations | Slightly above both approved strengths, published honestly. Decades of trial support for inflammatory lesions. It is a topical antibiotic sold for 'everyday use' with no stated review point and no mention of resistance anywhere on the page — a smaller concern for topical than oral metronidazole, but the kind of thing a stated duration would settle. |
| IvermectinAntiparasitic and anti-inflammatory — reduces Demodex density and the response to it | 0.88% | 1% is the approved concentration | The strongest single agent in topical rosacea, and the one diluted below its approved strength. A twelve per cent shortfall is unlikely to matter much clinically and it is an honest consequence of compounding three products together — but of the three, this is the one you would least want to weaken, and the page does not acknowledge that any of the numbers depart from their approved values. |
Scoring
- EVIDENCE FOR THE ACTIVEWEIGHT 30%76/100
Three genuinely first-line rosacea actives, each with a real trial base, all published with concentrations. Held back because no trial has tested this combination — the pairing of three agents is pharmacologically plausible inference rather than evidence — because ivermectin sits below its approved strength, and because the page offers no clinical data of its own.
- FORMULATION INTEGRITYWEIGHT 20%82/100
The best-made compounded product we have assessed. An anhydrous silicone and ester base means no preservative is needed and none is present, which for inflamed rosacea skin removes a whole category of irritant. Penetration enhancers appropriate to driving azelaic acid from a waterless vehicle. An airless pump with a stated 0.3 ml actuator. Fragrance-free, with a full ingredient list. Marked down only for the non-standard strengths going unexplained.
- DISCLOSUREWEIGHT 15%50/100
The best in the Alloy range: three concentrations, a full ingredient list, an actuator volume to a tenth of a millilitre, the packaging named, a named medical reviewer, and a genuine safety question in the FAQ. Against that — no application frequency and no bottle size, so the supply claim is unverifiable; no pregnancy content for the sixth page running; no sunscreen on a condition where ultraviolet is a leading trigger; and no review point for an indefinite topical antibiotic.
- TOLERANCE IN USEWEIGHT 15%NOT ASSESSED
Not assessed, and it is the crux for this product. Rosacea skin is intolerant by definition, 17% azelaic acid stings reliably, and three actives at once compounds the question — while the preservative-free anhydrous base pushes the other way. A panel would settle whether the vehicle wins.
- TEXTURE & WEARWEIGHT 10%NOT ASSESSED
Not assessed. A silicone-heavy anhydrous base is a distinctive feel and worth a panel's time.
- COST PER APPLICATIONWEIGHT 10%60/100
$99 for a stated three-month supply is $33 a month for three prescription actives in a well-made base, with unlimited physician access and delivery included — good against buying the three approved products separately, which would cost several times more. Held back because without a bottle size or a frequency the per-application cost cannot be computed, despite the actuator volume being published.
What it is
A compounded prescription cream combining the three first-line topical treatments for rosacea — azelaic acid 17%, metronidazole 1.11% and ivermectin 0.88% — in a fragrance-free anhydrous base, dispensed from an airless pump with a 0.3 ml actuator. $99 for a stated three-month supply, or $33 a month, with unlimited physician access, free delivery and HSA/FSA eligibility included.
Read the ingredient list — there is no water in it
The full list runs: azelaic acid, metronidazole, ivermectin, C13-15 alkane, caprylyl methicone, cyclopentasiloxane, diethylene glycol monoethyl ether, dimethicone, dimethyl isosorbide, moringa oil and its hydrogenated esters, passionfruit seed oil, PEG-12 dimethicone crosspolymer, pentaerythrityl tetraisostearate, tocopherol, tocopheryl acetate.
No aqua. This is an anhydrous vehicle — silicones, alkanes, esters and oils, with no water phase at all. That has one consequence worth spelling out: a product with no water does not need a preservative, and this one has none. No phenoxyethanol, no parabens, no benzyl alcohol.
Preservatives are among the more common contact irritants in leave-on products, and rosacea patients are the population most likely to react to them. Building an anhydrous base to eliminate the whole category is more expensive and harder to formulate than adding phenoxyethanol to a cream. Somebody chose to do it, and the two penetration enhancers carried alongside — diethylene glycol monoethyl ether and dimethyl isosorbide — are exactly what you would use to get azelaic acid out of a waterless vehicle and into skin. At the time of review this was the most competent formulation work we had seen, and it is still the best of any compounded product here — R-52 has since taken the outright title with a microencapsulated oxidiser.
The airless pump is the same instinct. So, remarkably, is publishing the actuator volume: 'We designed it with a 0.3mL actuator for precise, mess-free application.' Nothing else in this register tells you how much product one press delivers.
Three approved drugs, none at its approved strength
Because Alloy publishes the numbers, they can be checked against the products these actives come from.
Approved comparators: azelaic acid 15% for rosacea, metronidazole 1%, ivermectin 1%. Two of the three sit slightly above their reference and one sits below. This is the ordinary arithmetic of blending three products into one tube, and publishing it is to Alloy's credit — but the page does not note that any of the three departs from its approved value.
The ivermectin is the one to notice. It is the strongest single agent in topical rosacea — it outperformed metronidazole head-to-head on lesion counts — and it is the one that came out of the blend diluted. A twelve per cent shortfall is unlikely to change an outcome much, and it is an honest by-product of compounding rather than a cost saving. But of the three, it is the one you would least want weakened, and the page presents all three numbers as though they were chosen rather than arrived at.
The larger evidence point is the combination itself. Azelaic acid, metronidazole and ivermectin are each first-line, each by a different mechanism, and no trial has ever tested all three together. Guidelines support monotherapy and certain pairs. Putting three in one tube is pharmacologically reasonable inference — and it is inference, on skin that is intolerant by definition.
The claim we expected to be wrong
'Rosacea is related to hormonal imbalance, with the incidence and severity rising for women aged 45 and older.' From a menopause company, that reads like a condition being bent toward the franchise, and we went looking for the overreach.
It holds up. Oestrogen and progesterone are vasomodulators; the estradiol protective hypothesis links falling oestrogen in perimenopause to increased rosacea prevalence; oestrogen's general anti-inflammatory effect on skin declines at the same time; and rosacea skin shows heightened Toll-like receptor 2 activity that is responsive to hormonal as well as environmental change. Prevalence and severity do rise in women of this age.
This is the second time in the Alloy series that a claim we assumed was marketing survived checking — the first being that topical estriol does not measurably alter circulating hormone levels. On both occasions the company was making a defensible scientific point in loose language. It is worth recording that a menopause specialist framing rosacea as partly hormonal is better placed to say so than a general skincare brand, and said it accurately.
One number short, for the fourth time
Alloy publishes 0.3 ml per actuation. It does not publish how many actuations, how often, or how large the bottle is.
So the most precisely specified dose figure in this register cannot be turned into a daily dose, a monthly consumption, or a check on the three-month claim. The pattern is now consistent across the range: the face cream published a full list and no concentration, the body treatment a concentration and no dose, the tretinoin cream a fill weight and a dose but no concentration, the lash serum a fill size that contradicted the supply claim, and this one an actuator volume with nothing to multiply it by.
Two omissions are specific to the condition rather than the company. Ultraviolet is among the most consistently reported rosacea triggers and daily photoprotection is a cornerstone of management — sunscreen and SPF appear zero times. And trigger avoidance generally, which for rosacea is close to half the treatment, gets no guidance at all. Dermatica's rosacea page, which we criticised heavily for promising to clear rosacea 'for good', at least contained a proper trigger FAQ. This one does not.
There is also a topical antibiotic in this cream, described as being for everyday use, with no stated review point and no mention of resistance. Topical metronidazole is a far smaller stewardship concern than an oral antibiotic, and we are not going to inflate it into one. A sentence about how long the course runs would still be the difference between a treatment plan and a subscription.
A heading over the wrong molecule
One of the page's three feature blocks is headed 'Less Burning and Stinging'. The text underneath explains that inflamed skin stings and that the cream eases irritation by clearing papules and pustules — which is a claim about treating rosacea, not about the product being gentle.
Read as a heading, though, it says the cream stings less. It sits directly above a formula containing 17% azelaic acid, which is above the rosacea-approved strength and is the most reliably stinging topical in the category. The anhydrous preservative-free base genuinely does push in the other direction, and the net result may well be a well-tolerated product. But the heading is making a tolerability promise the ingredient list does not obviously support, and a panel would be needed to settle it.
If you are considering it
- Establish which rosacea you have. This treats papules and pustules well; nothing in it addresses flushing or visible vessels.
- Ask how many actuations, how often. The page gives the volume per press and nothing to multiply it by.
- Ask how long the metronidazole is meant to run, and what you step down to.
- If you have stung on azelaic acid before, say so — this is above the rosacea-approved strength.
- If preservatives are a problem for your skin, mention it, because this being anhydrous and preservative-free is a genuine and rare advantage.
- Buy sunscreen. Ultraviolet is a leading trigger and this page never mentions it.
- Do the trigger work — heat, alcohol, spice, stress — which the page also omits and which is half of rosacea management.
- Expect improvement over eight to twelve weeks, in line with the evidence for each of these agents.
Where we stand
At 70 this is the second Alloy product we have not marked with caution, and it is the one where the company looks most like a pharmaceutical developer rather than a marketing operation. An anhydrous, preservative-free, penetration-enhanced, airless-pumped triple combination is not something you arrive at by accident, and publishing three concentrations, a full ingredient list and an actuator volume is more composition disclosure than any compounded product in this register offers.
It lands a point below Dermatica's rosacea treatment, which is a fair place for it and reached from the opposite direction. Dermatica offers a pool of four actives at approved strengths and lets a prescriber choose, then ruins its page with a promise to clear rosacea for good and an undosed oral antibiotic. Alloy fixes one combination that nobody has trialled, at strengths nobody has explained, in a vehicle better than anything Dermatica describes — and then declines to say how often to apply it.
State a frequency and a bottle size. Note that the three strengths are the result of blending, because a reader who checks will notice. Add a line on sunscreen and one on triggers. This is the closest Alloy has come to a product we would recommend, and the gap is entirely in the instructions rather than the tube.
Who this is for
- Someone with papulopustular rosacea who wants all three first-line topicals in one application rather than three prescriptions.
- Someone whose skin reacts to preservatives — this is a rare preservative-free prescription option and that is a genuine reason to choose it.
- Someone in perimenopause whose rosacea has worsened, where the hormonal framing on this page is accurate and useful.
- Someone who will ask the prescriber for a frequency and a duration, because the page supplies neither.
- Someone who will wear daily sunscreen and do the trigger work themselves.
- Your rosacea is mainly flushing and visible vessels. All three of these treat inflammatory lesions; none treats telangiectasia.
- You have reacted badly to azelaic acid before — 17% is above the rosacea-approved strength and it is the reliable stinger of the group.
- You are pregnant or breastfeeding and want a position from the page. It offers none, though this formula is among the more benign in Alloy's range on that front.
- You want a treatment whose specific combination has been trialled. This one has not.
- You want to know what you are paying per application.
Ask how many actuations, how often, and for how long the metronidazole runs. The formulation work here is excellent; the instructions are missing.
This is an editorial assessment of published information about a prescription product. It is not a diagnosis, not a prescription and not a substitute for your own prescriber. Hydroquinone and tretinoin are drugs. Decisions about them belong with a clinician who has seen your skin.
Sources
- S-01Alloy — Rosacea Face Cream Rx product page The $99 three-month price, azelaic acid 17%, metronidazole 1.11% and ivermectin 0.88%, the full anhydrous ingredient list, the airless pump and 0.3 ml actuator, the 'Less Burning and Stinging' heading, the hormonal framing, and the absence of frequency, bottle size, pregnancy, sunscreen and trigger content. Read 28 July 2026.
- S-02Dermatica — rosacea treatment page The direct comparator reviewed at R-24: ivermectin 1% and metronidazole 0.75% at approved strengths from a four-active pool, with a genuine trigger FAQ this page lacks.
- S-03Rosacea: pathogenesis and therapeutic correlates (2024) The cathelicidin, Toll-like receptor 2 and Demodex mechanisms underlying all three actives in this formula, and the multifactorial pathogenesis.
- S-04Estrogen and hormone changes play a role in rosacea and skin alterations The estradiol protective hypothesis and the rise in rosacea prevalence and severity around perimenopause, which supports this page's hormonal framing.
- S-05Rosacea and menopause Falling oestrogen as a vasomodulatory contributor to rosacea in midlife women — the basis for crediting rather than criticising the page's 'related to hormonal imbalance' claim.